1609003748 NPI number — Dr Erika Leigh Johnson MD ERIKA LEIGH JOHNSON MD

Table of content: ERIKA LEIGH JOHNSON MD (NPI 1609003748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609003748 NPI number — Dr Erika Leigh Johnson MD ERIKA LEIGH JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Dr Erika Leigh Johnson MD
Provider Last Name:
JOHNSON
Provider First Name:
ERIKA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609003748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12264 TAMIAMI TRL E
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34113-7942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-352-9991
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12264 TAMIAMI TRL E
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34113-7942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-352-9991
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
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Authorized Official Title or Position:
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Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME124467 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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